HomeMy WebLinkAbout1998-010067 - temp sign ' ,� PERMIT
rrlTlh OF ORONO PERMIT TYPE:
�750 Kelley Parkway- P.O. Box 66 �_��U��
Cr ystal Ba y, Minnesota 55323 Permit Number: ;;;��fi fr,:
(612) 473-7357 Date Issued: !;:_;;i;:;� ;r=:�;�;
SITE ADDRESS:
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DESCRIPTION:
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FEE SUMMARY:
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APPL�CANT/PERMITEE SIGNATURE �_ ISSUED BY:SIGNATURE
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Tot�l Fee: $ Date Received:
Entered By: Permit#:
CITY OF ORONO - BUII..DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNE R CONTRACTOR
JOB SITE ADDRESS: ��`7`�� ���jPP��1i ��� ZIP:
AME OF OWNER: /e�' ������ PHONE: ome �f�/-37�60
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(vyork) 9f�9-�/ �0.���2
MAII�ING ADDRESS: /50Dg S�i,�..���� ��j� CITY:�KU�u�c��/c� ZIP:. ,53�16" .
CONTRACTOR: P : L/3 �-3T CS
CONTACT PERSON: ��l��,o MOBILE AGER: `/O/�'-D/D
MAII.ING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION�
TYPE OF WORK: New Addition Accessory Structure
Move � Remodel/Alteration Land Alteration
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PROPOSED WORK(describe in detain: �P�Q ��'�, _
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION(excluding lancn: $ ���
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the or ' ces and codes of the City and with
the State Buil�iing Code; that I understand 's is no t and work is not to start without a
permit; and that the work will be in ac ance e proved plan.
APPLICANT'S SIGNATURE: Z DATE:
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGHTS OF SUBJECTS OF DATA
Subd. 1. Type of data. The righ�s of individual on whom the data is stored or to be scored shall be as set forth in this seedon.
Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)the purpose and inrended use af the cequested dara within the collecang 3tate agency,political subdivision,or statewide system;
(b)whecher he may refuse oti is legally required to supply t6e requested data:(c)any Irnown consequence arising from lus supplying or refusing to supply
• private or confidendal dara;and(d)the idendry of other persoas or enddes auehorized by srdte or fedecal law ta receive the data. This requirement s6a11
noc apply when an individual is asked to supply invesdgadve dars,punuant to section 13.82,subdivision S,to a law enforcement o�cer. �
The commissioner of revenuc mav place che noace reauired under this subdivision in the individual income tax or prooem taz refund
instrucdons instead of on rhose forms.
Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject
of stored data on individuais,and whecher it is classified as public,private or confidentiai. Upon his further request,an individual who is the subjecc
of stored private or public data on individuals shall be shown[he data wichout any charge to him and;if he desires,shall be infocmed of the content
and meaning of ehat daca. Aher an individual has been shown che private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acdon pursuant to ehis secdon is pending or addiaonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible aurhoriry
may require thc requesting pcnon to pay[he actual cosc;of mak;ag,ce:t:ying,a:.d comp�ling the�opie5.
The responsible authoriry shall comply immediacely,if possible,with any request made pursuant to this subdivision,or within five days of
the date of the request,exciuding Saturdays.Sundays and►egal holidays,if immediate compliance is not possible. If he canaot comply with the request
within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,exciuding Saturdays.
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public oc private
daca concerning himself. To exercise�his right,an individuai shali noafy in wriang the responsible authority describing che nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of
inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual thac he believes the data to be correct. Data
in dispute shall be disclosed oniy if che individual's statemenc of disagreement is included with the disctosed daca.
The de[erminaaon of the responsibte authoriry may be appealed pursuant to the provisions of the adminisaaave procedure act relating to
contesud cases.
DATA PRIVACY ADVISORY . .
In accordance with M.S. 13.04, Subd.2, "Ri;hts of subjects of data",we would like to inform you that your request
for a permit or license from the City of Orono or any of its deparcments may require you to furnish certain private or
confidential information.
You are notified that: �
1. The information you furnish will be used to determine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First ytiddle Last
Address .
C�h, Stace Zip Phone
I understand my rights as stated above.
Signacure